Anfepramona (Diethylpropion) for Weight Loss Management
Anfepramona (diethylpropion) is conditionally recommended for short-term weight management in patients with obesity or overweight with weight-related complications, but should not be used as a first-line treatment due to limited long-term efficacy and safety data. 1
Indications and Efficacy
Anfepramona is FDA-approved as a short-term adjunct (a few weeks) for weight reduction in patients with:
- Initial BMI ≥30 kg/m² who have not responded to weight reducing regimens alone 2
- Should be used alongside caloric restriction 2
Clinical efficacy data shows:
- Average weight loss of 3.0 kg over 6-52 weeks compared to placebo 1
- More recent studies demonstrate better outcomes:
Administration and Dosing
- Available in two formulations:
- 25 mg immediate-release tablets (taken 3 times daily before meals)
- 75 mg extended-release tablets (taken once daily in the morning) 1
- Should be used as part of a comprehensive weight reduction program including diet and exercise 2
- Treatment should be discontinued if inadequate weight loss (less than 4 pounds) within the first 4 weeks 2
Safety Considerations and Contraindications
Anfepramona is contraindicated in patients with:
- History of cardiovascular disease 1
- Uncontrolled hypertension 1
- Anxiety disorders or agitated states 1
- History of drug abuse 1
- Use of MAOIs 1
- Pregnancy and breastfeeding 1
- Hyperthyroidism (risk of arrhythmias and seizures) 1
- Glaucoma 1
Common adverse effects include:
- Dry mouth, insomnia, headache, irritability 1
- Constipation, anxiety 1
- Cardiovascular effects: palpitations, tachycardia, elevated blood pressure 1
Serious concerns:
- Risk of pulmonary hypertension with prolonged use 2
- Potential for valvular heart disease (although rare with monotherapy) 2
- Classified as a Schedule IV controlled substance due to potential for abuse and dependence 1
Monitoring Requirements
- Blood pressure and heart rate should be monitored periodically 1
- Baseline cardiac evaluation should be considered to detect preexisting valvular heart disease or pulmonary hypertension 2
- Discontinue immediately if symptoms of pulmonary hypertension develop (exertional dyspnea, angina, syncope, lower extremity edema) 2
Limitations and Special Considerations
- FDA-approved for short-term use only (12 weeks) 1
- Limited long-term safety and efficacy data beyond 12 months 1
- Should not be used in combination with other anorectic agents 2
- May impair ability to operate machinery or drive 2
- Tolerance may develop with prolonged use 2
Clinical Decision Algorithm
Patient Selection:
- BMI ≥30 kg/m² or BMI ≥27 kg/m² with weight-related comorbidities
- Failed adequate trial of lifestyle modifications alone
- No contraindications as listed above
Treatment Initiation:
- Start with 25 mg three times daily before meals or 75 mg ER once daily
- Provide concurrent dietary counseling (1500 calories/day restriction recommended) 5
- Set clear weight loss goals and expectations
Monitoring:
- Assess weight loss at 4 weeks
- Continue only if ≥4 pounds lost 2
- Monitor BP and HR at each visit
- Assess for adverse effects, particularly CNS and cardiovascular symptoms
Duration:
- FDA-approved for short-term use (12 weeks)
- If considering off-label longer use, carefully weigh risks vs. benefits 1
- Consider switching to medications with better long-term safety data for chronic management
Comparative Efficacy
When considering weight loss medications:
- GLP-1 receptor agonists (semaglutide, liraglutide) show superior efficacy and safety for long-term management 1
- Phentermine may produce slightly greater weight loss than diethylpropion (anfepramona) 5
- Combination therapies like phentermine-topiramate ER show better efficacy than anfepramona monotherapy 1
In conclusion, while anfepramona can be effective for short-term weight management, its use should be limited to carefully selected patients, with close monitoring for adverse effects, and consideration of more effective long-term options for chronic weight management.